| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,730 |
2,520 |
$447K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,858 |
9,553 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
9,663 |
9,558 |
$267K |
| D1120 |
Prophylaxis - child |
6,575 |
6,510 |
$230K |
| D1110 |
Prophylaxis - adult |
4,167 |
4,127 |
$214K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,885 |
1,751 |
$213K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,288 |
533 |
$177K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,134 |
1,128 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,481 |
10,368 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
11,165 |
10,984 |
$131K |
| D0274 |
Bitewings - four radiographic images |
3,610 |
3,567 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
1,881 |
1,850 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
751 |
494 |
$73K |
| D9248 |
|
621 |
605 |
$68K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
813 |
336 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,141 |
660 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,517 |
1,489 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,693 |
1,524 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,254 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,447 |
1,424 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
39 |
$24K |
| D1351 |
Sealant - per tooth |
678 |
248 |
$18K |
| D1206 |
Topical application of fluoride varnish |
950 |
950 |
$13K |
| D2950 |
|
144 |
122 |
$7K |
| D2331 |
|
57 |
39 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
24 |
$3K |
| D2332 |
|
19 |
14 |
$2K |
| D2330 |
|
22 |
15 |
$2K |
| D0270 |
|
68 |
68 |
$307.97 |
| D0603 |
|
10,825 |
10,726 |
$0.01 |
| D1999 |
|
910 |
805 |
$0.00 |
| D0602 |
|
1,402 |
1,379 |
$0.00 |
| D0601 |
|
108 |
105 |
$0.00 |